Purpose for the program: The Birthways Lactation Services program's purpose is twofold.  We want to increase breastfeeding initiation and duration rates, thereby improving long term health for every baby.  We also want to increase lactation consultant's  productivity while decreasing FTE's and cost.  Most lactation programs have lost state funding in recent years and are now funded by hard to find grants or, as in our hospital's case, by community benefit dollars. 

Proposed change: For ten years, our program was set up to provide home visits to our clients (within  50 mile radius) who either chose to have a visit or were physician ordered.  Eight years ago it was determined this was a costly way to deliver care even with funds provided by a grant and some insurance reimbursement. At that time we started the clinic model and were encouraged by the positive results.  Our LC's cross train to the discharge planning position on Birthways where they round with the pediatricians, schedule the clinic visits at discharge, and provide a discharge feeding plan for babies with feeding problems.

Implementation, outcomes and evaluation: The coordinator of the lacation program and her team perform 3-5 day rechecks, which include a weight, jaundice, and lactation evaluation.  We believe our outcomes reflect the success of the program.  Our breastfeeding initiation rate is 87.6% as compared with the state's 73.9%.  Our 6 month breastfeeding rate is 79.3% (one of the best in the state) as compared to 17% nationally according to the CDC.  We are ahead of the  Healthy People 2020 goals of 81.9% initiation of breastfeeding and 60.6% 6 months duration.  Our home visit model took 3.1 FTE's, and our clinic model takes 1.2 FTE's so a savings of over $140,000 in salaries and mileage reimbursement.  Our lactation consultants can see 5 more babies a day or 25 more a week which makes it possible to give second visits to those clients who need them. 

Implications for nursing practice: The advantages of breastfeeding are well researched and well documented. We believe our program model is best practice and is leading the way in breastfeeding promotion and support of the AAP's Policy Statement and the US Surgeon General's Call to Action to Support Breastfeeding.  Our service model decreases hospital readmission rates and promotes exclusive breastfeeding with increased productivity and decreased cost.

Keywords: lactation program, exceeding national/state breastfeeding rates.